Endocrine Abstracts

Background: The use of Dolutegravir (DTG) in the treatment of patients with HIV has been associated with reports of unexpected excess weight gain. The present study aimed to investigate the effect of DTG on the adrenal cortisol levels of HIV patients initiated on antiretroviral therapy (ART).

Methods: Adult patients (≥18 years) newly initiated on ART were recruited into two groups (n-100 participants in each group). One group was initiated on a DTG-based regimen and compared to an age and sex-matched group initiated on non-DTG-based ART, between July 2020 and July 2021. A third non-HIV infected age- and sex-matched group of adults (n = 100) was used as the negative control. Serum cortisol was measured at baseline, after 30 mins and after 1-hour post-stimulation with 250 mg of synthetic ACTH. Salivary cortisol was also measured. The serum and salivary cortisol levels of the two groups were compared using a chi-square test.

Results: The mean basal serum cortisol in the DTG based ART regimen group was similar to that in the non-DTG based ART regimen group (323.79±9.06 mmol/l vs 318.94±10.37 mmol, respectively), P = 0.338. Basal salivary cortisol (8 am) was also similar between the DTG-based and non-DTG-based groups: (1.57±0.09 nmol vs 1.68±0.15nmol, respectively), P = 0.224. After stimulation with 250 mg of synthetic ACTH, there was no statistically significant difference in the serum and salivary cortisol levels of the two groups. Normal adrenal function was observed in 63.5%, and 65.8% of the population on DTG, non-DTG groups respectively P = 0.776 and adrenal hyperfunction in13.4%,12.7% respectively (P = 0.537).

Conclusion: This study has demonstrated that DTG does not cause adrenal dysfunction in adult patients with HIV and it can be deduced that metabolic side effects reported from the use of DTG may not be from excess cortisol. There is the need to conduct large scale multicenter studies.